Conjunctiva
Conjunctivitis
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Conjunctivitis
See Also
Acute Red Eye
Conjunctivitis in Newborns
Symptoms
Eye Discharge
Bacterial Conjunctivitis
: Mucoid, purulent discharge
Viral Conjunctivitis
: Watery discharge
Allergic Conjunctivitis
: Mucoid discharge
Eye Pain
minimal
Scratchy foreign body
Sensation
Worse pain in
Corneal Injury
,
Iritis
,
Keratitis
and
Acute Angle-Closure Glaucoma
Photophobia minimal
Worse in acute
Iritis
or
Keratitis
Signs
Conjunctiva
erythema
Palpebral
Conjunctiva
injection
Diffuse erythema over bulbar
Conjunctiva
Cornea
normal
Epithelial defect in
Corneal Injury
or diffuse uptake in
Keratitis
Fluorescein
stain
Diffusely cloudy in acute
Glaucoma
Visual Acuity
normal
Vision
blurred in acute
Iritis
and
Corneal Injury
Vision
markedly reduced (<20/200) in acute
Glaucoma
Pupil
size and reactivity normal
Small pupil in
Corneal Injury
or
Iritis
Dilated non-reactive pupil in
Glaucoma
Intraocular Pressure
normal
Elevated in acute
Glaucoma
No
Ciliary Flush
Contrast with
Iritis
and
Glaucoma
Preauricular Lymphadenopathy
Seen in
Viral Conjunctivitis
(not in
Bacteria
l)
Differential Diagnosis
Red Eye
Keratitis
Episcleritis
Uveitis
Acute
Iritis
Scleritis
Narrow Angle Glaucoma
Subconjunctival Hemorrhage
Mucous membrane
Pemphigoid
Sjogren Syndrome
Kawasaki Disease
Stevens-Johnson Syndrome
Carotid Cavernous Fistula
Causes
Common
Infectious
Viral Conjunctivitis
(esp.
Adenovirus
)
Bacterial Conjunctivitis
Non-Infectious
Allergic
Dry Eye
Toxic or
Chemical Reaction
Contact Lens
use
Occult
Conjunctiva
l neoplasm
Foreign body
Factitious
Idiopathic
Causes
Serious Conditions to Exclude
Herpes Simplex Conjunctivitis
Unilateral
Conjunctiva
l/
Corneal Inflammation
with severe pain
Concurrent
Cold Sore
s may be present
Dendritic Ulcer
s on
Fluorescein
staining of
Cornea
Herpes Zoster
See
Herpes Ophthalmicus
Observe for
Herpes Zoster
lesions in the V1 or V2 distribution
Hutchinson sign (
Vesicle
s on the tip of the nose)
Chlamydial Conjunctivitis
Unilateral Conjunctivitis with hyperemia and mucopurulent discharge
May present as subacute case (>4 weeks)
Lymph
oid follicle formation (also seen in some
Viral Conjunctivitis
)
Tiny, rice grain size, gelatinous pale bumps on the
Conjunctiva
Gonococcal Conjunctivitis
(
Hyperacute Bacterial Conjunctivitis
)
Severe purulent
Eye Discharge
,
Eye Pain
and decreased
Vision
Risk of
Cornea
l involvement including
Corneal Ulcer
ation
Obtain cultures and treat systemically for both
Gonorrhea
and
Chlamydia
Labs
Eye
Gram Stain
and culture indications
Corneal Ulcer
ation
Orbital Cellulitis
Severe recurrent or refractory eye infection
Other testing to consider
Chlamydia PCR
Giemsa Stain and viral culture for herpes
Management
See Specific management protocols
See
Viral Conjunctivitis
See
Epidemic Keratoconjunctivitis
See
Bacterial Conjunctivitis
See
Allergic Conjunctivitis
See
Gonococcal Conjunctivitis
See
Herpes Simplex Keratitis
See
Vernal Conjunctivitis
Management
Ophthalmology Referral Indications (typically at one week)
Contact Lens
users
Topical Corticosteroid
s required
Photophobia
No improvement after 7 days
Resources (Include Patient Education)
See
Conjunctivitis Resources
References
Azari (2013) JAMA 310:1721-9 [PubMed]
Cronau (2010) Am Fam Physician 81(2): 137-44 [PubMed]
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